Objective To investigate the clinical characteristics and the related factors of peripapillary subretinal hemorrhage (PPSRH). Methods The clinical documents of fundus fluorescein angiography (FFA) of 23 patients (23 eyes) with PPSRH were retrospectively analyzed. Results All of the 23 eyes was myopes with middle or slight degree, and the corrected visual acuity was≥1.0. Among the 23 patients, 9 eyes were PPSRH, 13 eyes were PPSRH with disc hemorrhage, and 1 eye was PPSRH with disc and vitreous hemorrhage. All of the PPSRH was localed at the nasal edge of optic disc. Through FFA the hemorrhage showed blocked fluorescence and the optic disc showed nodular hyperfluorescence at the late phase, and nothing abnormal in the unaffected eyes. Conclusion PPSRH might be related to buried optic disc drusen. (Chin J Ocul Fundus Dis, 2002, 18: 96-97)
ObjectiveTo investigate the clinical characteristics and prognosis of cerebral hemorrhage in young and elderly patients, to provide evidences for individual clinical diagnosis and treatment, and lay a foundation for building a predictive model of prognosis in cerebral hemorrhage.MethodsPatients with spontaneous cerebral hemorrhage in the Third People’s Hospital of Chengdu were recruited prospectively and continuously from January 2014 to January 2019. They were divided into the youth group (≤50 years old) and the elderly group (>50 years old), and their risk factors, disease characteristics, etiology, and prognosis were analyzed.ResultsA total of 757 patients were recruited. There were 160 cases (21.1%) in the youth group, including 120 males and 40 females, aged from 17 to 50 years, with an average age of (42.06±7.62) years old; 597 cases (78.9%) in the elderly group, including 361 males and 236 females, aged from 51 to 96 years, with an average age of (69.34±10.56) years old. The incidences of hypertension (74.2% vs. 51.2%), diabetes (15.1% vs. 4.4%), coronary heart disease (12.1% vs. 1.3%), and the level of blood glucose at admission [7.1 (5.8, 8.4) vs. 6.3 (5.3, 8.1) mmol/L] in the elderly group were higher than those in the youth group (P<0.05), respectively. However, the proportions of males (60.5% vs. 75.0%), smoking (24.5% vs. 36.9%), and the diastolic blood pressure at admission [(92.37±18.50) vs. (100.95±25.25) mm Hg (1 mm Hg=0.133 kPa)] in the elderly group were lower than those in the youth group (P<0.05), respectively. There was no significant difference between the two groups in systolic blood pressure at admission, Glasgow Coma Score, National Institutes of Health Stroke Scale score, initial hematoma volume, hematoma enlargement, brain hernia, location of hemorrhage, midline shift, hydrocephalus, combined subarachnoid hemorrhage, or intraventricular extension (P>0.05). Hypertension was the most common etiology in the two groups. There was a significant difference in the etiology of cerebral hemorrhage between the two groups (P<0.05), the difference was mainly reflected in cerebral amyloid angiopathy, cavernous hemangioma, and arteriovenous malformation. The fatality rate during hospitalization (9.4% vs. 20.9%), 3 months after discharge (10.3% vs. 26.3%), and at 1 year follow-up (19.0% vs. 37.6%) in the youth group was lower than that in the elderly group (P<0.05), respectively. The disability rate 3 months after discharge and at 1 year follow-up in the youth group was lower than that in the elderly group (32.1% vs. 44.2%, 16.9% vs. 34.4%; P<0.05), respectively.ConclusionsThe education of healthy lifestyles should be strengthened to reduce the adverse effects of smoking in young patients. Young patients should choose antihypertensives that can control diastolic blood pressure better. There are more structural abnormalities in young patients, so routine vascular examination is reasonable. It is necessary to focus on whether the original underlying diseases are stable in elderly patients. Cerebral amyloid angiopathy is an important cause of cerebral hemorrhage in elderly patients, and is a risk factor of recurrence. Anticoagulation or antiplatelet therapy should be cautious.
Objective To investigate the incidence, risk factors and relationship with intraocular hemorrhage of Tersonprime;s syndrome among patients with spontaneous subarachnoid hemorrhage (SSAH) after emergency admission. Methods Seventy-four consecutive patients with SSAH from June 2010 to September 2011 were prospectively examined. A direct ophthalmoscope examination was performed in all participants within three hours after emergency admission. If circumstances permit, fundus photos were taken. When initial fundus examination was conducted, the Hunt-Hess grade was classified by the brain surgeon. The fundus examination was taken on the 1st, 3rd, and 7th day, 2 weeks, 1 month, and 3 months after emergency admission. The details were recorded, including sex, age, bleeding patterns, Hunt-Hess grade and death. The incidence of Tersonprime;s syndrome was analyzed and correlated with sex, age and Hunt-Hess grade. The relationship between intraocular hemorrhage and Hunt-Hess grade and mortality was analyzed. Results Among the 74 patients, 19 were suffering from Tersonprime;s syndrome, 31 eyes involved. The incidence of Tersonprime;s syndrome was 25.7%. Statistical analysis demonstrated that the sex of the patient was randomly distributed (chi;2=0.071,P=0.790), and the age components were also randomly distributed (Fisherprime;s exact test.P=0.203). The Hunt-Hess grade components were nonrandomly distributed (Fisherprime;s exact test，P=0.000). Among the patients with preretinal hemorrhage and vitreous hemorrhage, Hunt-Hess grade Ⅴ was in 76.9% patients; among inte-retinal hemorrhage, Hunt-Hess grade was in 16.7% of patients. The distribution was non-random (Fisherprime;s exact test.P=0.041). All intraocular hemorrhages were found at the time of first fundus examination. The mortality from Tersonprime;s syndrome was 68.4% (13/19) according to the follow-up investigation. The mortality in patients with vitreous hemorrhage and preretinal hemorrhage was statistically different (Fisherprime;s exact test.P=0.046) from patients with inter-retinal hemorrhage. Among the six recovered Tersonprime;s syndrome patients, two of them were recovered from vitrectomy, and the other four were recovered from selfabsorption. Conclusions A higher frequency (25.7%) of Tersonprime;s syndrome was observed in patients with SSAH. The incidence is highly related to the general condition of the patient but not to the sex or age. Intraocular hemorrhage is more likely to happen in the early time of SSAH. People with more severe intraocular hemorrhage may have worse general condition or higher mortality.
Objective To study prospectively the morphological relations among hemorrhage of optic disc, defect of retinal nerve fiber layer, and peripapillary atrophy in normal-tension glaucoma (NTG). Methods Qualitative and quantitative methods were applied to evaluate the relations among hemorrhage of optic disc, defect of retinal nerve fiber layer, and peripapillary atrophy by using stereo ocular fundus photography and computer analyzer systems. Results In 37 patients (42 eyes) in NTG hemorrhage group, 50 hemorrhagic spots at optic disc was found, including coloboma of retinal nerve fiber layer in 35 eyes (83.3%)(35/42). In 35 patients (40 eyes) in non-hemorrahge group, partial coloboma of retinal nerve fiber layer was found in 21 eyes (52.5%)(21/40). The difference of incidence of coloboma of retinal nerve fiber layer between the two groups was not significant (chi;2=1.403, P=0.236). The incidence of atrophic arc in hemorrhage group differed much from which in non-hemorrhage group (chi;2=7.008, P=0.008). The area of atrophic arc at beta;section in hemorrhage group ［(2.05plusmn;0.88)mm2］ was significantly different from which in non-hemorrhage group［(1.42plusmn;0.53)mm2］(t=-2.618, P=0.012). In the follow-up period, the difference of incidence of disc-rim loss between hemorrhage and non-hemorrhage group was significant, (chi;2=5.802, P=0.016); while the difference of the incidence of visual field defect between the two groups was not. Conclusion In eyes with NTG, hemorrhage of optic disc, coloboma of retinal nerve fiber layer and atrophic arc are closely related. More disc-rim loss and changes of atrophic-arc area in hemorrhage group in the follow-up period suggests that hemorrhage of optic disc is the risk factor of development of NTG. (Chin J Ocul Fundus Dis, 2006, 22: 232-235)
Cerebral small vessel disease refers to a group of pathological processes, neuroimaging features, and clinical symptoms, with various etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. The onset of cerebral small vessel disease can be insidious. It has various symptoms, some of which can attack acutely. Acute cerebral small vessel disease is characterized by lacunar stroke and brain parenchymal hemorrhage. The latter mainly includes hypertensive hemorrhage and cerebral amyloid angiopathy. This article summarizes the research advances of acute cerebral small vessel disease from the aspects of pathogenesis, clinical manifestations, neuroimaging features, and treatment methods, discussing characteristics and clinical challenges.
Purpose To evaluate the efficacy of vitreous surgery for treatment of fundus damages caused by ocular blunt trauma. Methods Clinical records were reviewed retrospectively for a series of consecutive 101 patients (105 eyes) with fundus damages caused by ocular blunt trauma underwent vitreous surgery from October 1992 to March 1998． Results Based on clinical examination and findings during surgery,all cases were divided into 4 subgroups:vitreous hemorrhage(VH)in 23 yes,VH with retinochoroidal rupture or optic damage in 25 eyes,traumatic retinal detachment in 46 eyes,and retinal giant tear in 11 eyes.Vision acuity improvement achieved in 77 eyes(73.3%)and of them 69 eyes(65．7%)had 0.02～0．6with 38 eyes(55．0%)better than 0．1.Two eye s with no light perception obtained better than 0.1． Visual acuity remained unchanged in 26 eyes(24.8%)and 2 eyes(1.9%)became worse after operation．The retina reattached in 54 eyes(94.7%). Conclusion Severe ocular blunt trauma may cause visual impairment and various fundus damages.Appropriate vitreous surgery can salvage most eyes with those injuries. (Chin J Ocul Fundus Dis,1999,15:100-102)
ObjectiveTo investigate the related factors of the retina1 hemorrhage in newborns. Methods9558 newborns included in this observation between March of 2012 and July of 2013 in our hospital. The fundus was examined by the fully-integrated wide-field digital imaging system RetCamⅢat 0-4 days after born. According to the literature, retinal hemorrhage was classified into degreeⅠ, ⅡandⅢ. The condition for baby and the mother during pregnancy were correlatively analyzed. The other factors were analyzed including twins, premature delivery, big baby, mode of delivery, fetal birth, forceps delivery, suction delivery, asphyxia, jaundice, ABO hemolytic, cranial hematoma, intracranial hemorrhage, maternal age, first-time mom, the maternal previous mode of production, emergency delivery, the first stage of labor prolonged, the second stage of labor prolonged, the third stage of labor prolonged, pregnancy-induced hypertension, gestational diabetes, oxytocin, prenatal body mass index (BMI). Multivariate logistic regression analysis was used. ResultsIn 9558 cases of newborns, retinal hemorrhages were found in 2753 infants (28.8%), including 1137 degreeⅠ(41.3%), 895 degreeⅡ(32.5%) and 721 degreeⅢ(26.2%). Multivariate logistic regression analysis showed that the mode of delivery, asphyxia, jaundice, advanced maternal age, maternal previous birth, prenatal BMI is a risk factor for neonatal values retinal hemorrhage (r=0.146, 5.841, 1.847, 0.071, 0.246, 0.965;P < 0.05). The degree of fundus hemorrhage was not related to birth weight and BMI (P > 0.05). ConclusionsThe neonatal retinal hemorrhage rate was 28.8%. Mode of delivery, asphyxia, neonatal jaundice, maternal age, the previous mode of delivery of mothers with more than one previous birth, prenatal BMI values may be risk factors lead to retinal hemorrhage.
ObjectiveTo review the research on the reasons of unplanned reoperation (URP) for degenerative lumbar spine diseases, and to provide new ideas for improving the quality of surgery for degenerative lumbar spine diseases. Methods The literature about the URP of degenerative lumbar spine diseases at home and abroad in recent years was reviewed and analyzed. Results At present, the reasons for URP include surgical site infection (SSI), hematoma formation, cerebrospinal fluid leakage (CSFL), poor results of surgery, and implant complications. SSI and hematoma formation are the most common causes of URP, which happen in a short time after surgery; CSFL also occurs shortly after surgery but is relatively rare. Poor surgical results and implant complications occurred for a long time after surgery. Factors such as primary disease and surgical procedures have an important impact on the incidence of URP. ConclusionThe main reasons for URP are different in various periods after lumbar spine surgery. Interventions should be given to patients with high-risk URP, which thus can reduce the incidence of URP and improve the surgery quality and patients’ satisfaction.
ObjectiveTo compare the effects of fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) on classifications and locations of choroidal neovascularization (CNV) located under subretinal hemorrhage in age-related macular degeneration, and on the areameasuring of subretinal hemorrhage.MethodsThe medical record of 177 patients with subretinal hemorrhage associated with AMD confirmed by photochrome of ocular fundus, FFA and ICGA examinations were retrospectively reviewed. The locations and classifications of CNV on the images of FFA and ICGA in the 177 patients and the area of subretinal hemorrhage of 30 patients randomly selected from the 177 patients were analyzed and measured. ResultsOn the images of FFA, the locations and classifications of CNV could be defined in 160 patients (90.4%), and CNV was considered eligible for laser therapy in 24 patients (13.6%). On the images of ICGA, the locations and classifications of CNV could be defined in 175 patients （98.9%），and CNV was considered eligible for laser therapy in 51 patients (28.8%). There was no statistical difference of the locations（Z=-0.383，P=0.701） and classifications （ χ2=2.993，P=0.810） of CNV on the images of FFA and ICGA. The areas of blocked fluorescence measured on the images of FFA (x-=26.610 mm2 and M=13.548 mm2) were larger than those of ICGA (x-=24.714 mm2，M=12.875 mm2) with statistical differences （Z=-3.000，P=0.003） between FFA and ICGA. ConclusionsICGA is beneficial for imaging CNV located under subretinal hemorrhage, and may increase the number of the patients who are considered eligible for laser treatment. The effect of measurement of the area of subretinal hemorrhage in AMD evaluated by FFA is better. (Chin J Ocul Fundus Dis,2003,19:149-151)
摘要:目的:动态观察大鼠脑出血后血肿周围组织补体激活与细胞凋亡的规律。方法:用胶原酶注入到大鼠尾状核的方法制作脑出血模型。将大鼠分为脑出血、假手术组、正常组3组。采用苏木素伊红(HE) 染色、免疫组织化学染色及原位末端脱氧核苷酸转移酶介导的dUTP 缺口末端标记法(TUNEL)分别观察各组在脑出血后第6 h、12 h、24 h、48 h、72 h、5 d、7 d时血肿周围补体C3、促凋亡基因(Bax)、抑凋亡基因(Bclxl)及TUNEL的表达。结果补体C3的表达峰值在24~48 h;TUNEL、Bax蛋白表达术后12h增加,48~72 h达高峰,而Bclxl蛋白表达高峰在48h。结论:大鼠脑出血后血肿周围组织补体C3的表达增加与细胞凋亡的演变趋势一致,C3与凋亡有相关。Abstract: Objective: To study the complement activation and apoptosis regular genes changes in the tissues of the perihematoma of intracerebral hemorrhage (ICH) in rats. Methods: Intracerebral hemorrhage was induced in rats by injection of bacterial collagenase into the caudate nucleus. Histopathological changes were studied in 6 h,12 h, 24 h, 2 d, 3 d, 5 d, 7 d after the injection. The immunohistochemistry and TUNEL analysis were performed. The expression of complement factor C3, the TUNELpositive cells, the proapoptotic gene expression (Bax) and the antiapoptotic gene (Bclxl) were examined. Results: The expression of C3 increased to its maximum between 2448 h. The TUNELpositive cells and Bax protein expression increased gradually and reached the peak level between 4872 h. The Bclxl protein reached the peak level at 48 h. The correlation analysis showed that the quantity of C3 was positively related to that of the TUNELpositive cells, but the bax protein was not related to Bclxl protein. Conclusion: The expression of complement factor C3 may contributes to the nerve injury after cerebral hemorrhage and relate to the apotosis in the tissues surrounding the hametoma in rats.